By Fathi Abumoghli
A severe shortage of medicines, medical supplies, and medical staff characterized the healthcare system in the Gaza Strip before the Israeli war against Gaza that started on October 7, 2023. Gaza’s weak health sector and its insufficient services are due to the Israeli blockade imposed on the Strip for the past 17 years. The ongoing war and Israel’s army targeting Gaza’s hospitals have deepened the health sector crisis and led to the shutdown of the majority of Gaza’s 35 hospitals, as they could no longer provide services to the thousands of injured and sick civilians, victims of the Israeli attacks.
In less than three months, the hospitals in Gaza had to deal with more than 100,000 Palestinians casualties. Working under unbearable conditions, doctors, nurses, and all other health teams dealt as efficiently and heroically as possible with the injured persons who arrived at their hospitals. Moreover, they bravely faced the threats issued by the Israeli army, who stated that the hospitals would be bombed unless the citizens and patients who had come to seek treatment or protection from the Israeli bombardment of their homes and neighborhoods agreed to leave.
Based on data issued by the Palestinian Central Bureau of Statistics, the population of the West Bank and Gaza Strip was estimated at 5,354,656 in 2022, of which 3,188,387 live in the West Bank and 2,166,269 in the Gaza Strip. At a growth rate of 2.4, the life expectancy is 73.2 years for males and 75.4 for females (73.5 years for males and 75.7 years for females living in the West Bank, and 72.5 years for males and 75 years for females living in Gaza).
The percentage of people in the age group of 0–14 years was estimated at 38 percent of the total population in Palestine in mid-2020 (with 36 percent of the total population in the West Bank and 41 percent in the Gaza Strip). The proportion of people aged 65 and over has declined, with an estimated 3 percent in mid-2020 in Palestine (4 percent in the West Bank and 3 percent in the Gaza Strip). The average size of a Palestinian family is 5.1 persons (4.8 in the West Bank and 5.6 in the Gaza Strip).
The displacement of 1.4 million citizens to Rafah, a small area that lacks the capacity to service more than 300,000 people, leaves the large numbers of displaced population threatened by humanitarian, health, and environmental disasters due to the lack of services.
According to statistics, 159 primary healthcare centers and 34 hospitals with 2,543 employees were operating in Gaza in early October 2023. On January 18, 2024, at the end of the 104th day of the Israeli war on Gaza, the official spokesperson for the Palestinian Ministry of Health in Gaza stated that the number of victims of the Israeli aggression has exceeded 24,620 killed and 61,830 wounded, including 337 health staff. In addition, the Israeli army has arrested 99 health staff since October 7, including hospital directors in northern Gaza. In total, 150 health institutions have been targeted by shelling, leaving 30 hospitals and 53 health centers out of service and destroying 122 ambulances.
The poor health situation has also led to the spread of epidemics. The Ministry of Health has recorded 8,000 cases of viral hepatitis A due to overcrowding and low levels of personal hygiene in places of displacement. The ministry also expects that the number of hepatitis C infections will double in various locations of displacement in the Gaza Strip where Ministry of Health staff cannot reach them.
The Ministry of Health has recorded hundreds of cases of miscarriage and premature birth due to panic and forced flight under Israeli military bombardment. Lack of healthcare in places of displacement and difficulties in accessing hospitals threaten the lives of about 60,000 pregnant women at risk of pregnancy complications.
In addition, there are 350,000 patients with chronic diseases who are exposed to complications due to the prevailing lack of medicines and the inability to access health services. In addition, 10,000 cancer patients experience serious complications that kill dozens of them every day due to the current lack of medicines and the lack of healthcare in places of displacement, while the only cancer hospital in Gaza has been put out of service.
Tedros Adhanom Ghebreyesus, director-general of the UN World Health Organization (WHO), informed member states that it is becoming harder to evaluate the functioning of the health system in Gaza. “What is clear is that the health needs of the people of Gaza are growing all the time, and the health system is near collapse,” he said as early as November 17, 2023.i
In his remarks in Davos, António Guterres drew attention to the situation in Gaza, saying, “The world is standing by as civilians, mostly women and children, are killed, maimed, bombarded, forced from their homes and denied access to humanitarian aid.” Mr. Guterres repeated his call for an immediate humanitarian ceasefire in Gaza, and a process that leads to sustained peace for Israelis and Palestinians, based on a two-state solution. “This is the only way to stem the suffering and prevent a spillover that could send the entire region up in flames,” he warned.ii
Today and surely in the days after the termination of the military operations, an evaluation of healthcare services should be conducted, and the health needs of the population of Gaza should be addressed. It is unclear how many healthcare centers out of 159 centers are still able to function efficiently. Likewise, we must assess how many of the 34 hospitals are still able to provide services, determine the status of their facilities and their 2,543 beds, and ascertain how many of the staff are still able to work.
Many questions remain unanswered: How many disabilities have resulted from the 100,000 wounded and are there appropriate rehabilitation facilities available to deal with, treat, and possibly rehabilitate these victims of the war? How many patients with psychological trauma caused by the war are in need of treatment and follow-up? How many diseases have been exacerbated by neglect and the shortage of medicines during the war? What level of infrastructure destruction, especially of electric power, water, and roads, has been incurred during the war? Who will fund the rebuilding of the destroyed health facilities and infrastructure? And finally, who will restore the smile to the faces of thousands of children who have lost their parents and siblings and to all the individuals who have lost relatives, friends, or colleagues?
i “WHO Director-General’s Remarks at the Informal Plenary Meeting of the United Nations General Assembly – 17 November, 2023,” World Health Organization, November 17, 2023.
ii “At Davos Forum, Secretary-General Warns of Global Norms Collapsing, Highlights Need to Rebuild Trust, Reform Governance,” United Nations, January 17, 2023.